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"~- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements <br />of the following terms and conditions: <br />1. To the best of my knowledge, all signiScan~ valuable and permanent man-made structure(s) in existence at the time this <br />application is filed, and located within 200 feet of the proposed affected azea have been identified in this application <br />(Section 34-32.5-115(4)(e), C.RS.). <br />2. No mining operation will be located on lands where such operations are prohibited bylaw (Section 34-325-11~(4)(f), <br />C.RS.; <br />3. As the applicanUoperator, I do not have any extraction exploration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Act for the E~draction of Construction Materials (Section <br />34-32.5-120, C.RS.) as determined through a Boazd finding. <br />4. I understand that statements in the apphcation are being made under penalty of perjury and that false statemenzs made <br />herein aze punishable as a Class 1 misdemeanor pursuant to Section 18-&503, C.RS. <br />t <br />Signed and dated this ~ day of ~~ ~~~j.Q,~. ~ [~C~ 01~ : "' _ <br />a• - <br />~~~~~Au \rOflS~•\~~ .~(. <br />Applicantl0per~or or Company Name <br />Signed: _ ~1_ 1 .df <br />Title ~ L~t~ ~~LC~M7 // <br /> <br />If Corporation A"ttest (Seal)l <br />Signed: <br />Corporate Secretary or quivalent <br />Town/City/County Clerk <br />State of <br />ss <br />County of ~~,ASC~nSA ) ~ ~, {~ %'~~~-~ <br />egoing instrumenLwas ac(mowledged~~beqfor~ s ~_ day of °~~.. <br />by asV lr p. ~ L~9r~Orc.r ~ (~ <br />-, . <br />_ ~ y ~ _ ~~~ <br />'" " - .. - ~ ''-~ `Notary Public <br />1\ <br />"RR"~ a-s-os <br />- _ My Commission expues. <br />SIGNATURES MUST BE IN BLUE INK ", <br />